Development of healthcare in the USSR. Historical essay on Russian healthcare. Post-war years. "health care in the USSR" in books

No. 3 ORDER OF THE MINISTER OF INTERIOR AFFAIRS OF THE USSR, MINISTER OF JUSTICE OF THE USSR AND PROSECUTOR GENERAL OF THE USSR “ON THE ORDER OF IMPLEMENTATION OF THE DECREE OF THE PRESIDIUM OF THE SUPREME COUNCIL OF THE USSR OF MARCH 27, 1953 “ON AMNESTY””

No. 3 ORDER OF THE MINISTER OF INTERIOR AFFAIRS OF THE USSR, MINISTER OF JUSTICE OF THE USSR AND PROSECUTOR GENERAL OF THE USSR “ON THE PROCEDURE FOR IMPLEMENTATION OF THE DECREE OF THE PRESIDIUM OF THE SUPREME COUNCIL OF THE USSR OF MARCH 27, 1953 “ON AMNESTY”” March 28, 1953 No. 08/012/85c Execution Decree of the Presidium of the Supreme Council USSR from 27

No. 24 JOINT ORDER OF THE PROSECUTOR GENERAL OF THE USSR, THE MINISTER OF INTERIOR AFFAIRS OF THE USSR AND THE CHAIRMAN OF THE KGB UNDER THE COUNCIL OF MINISTERS OF THE USSR

No. 24 JOINT ORDER OF THE PROSECUTOR GENERAL OF THE USSR, THE MINISTER OF INTERIOR AFFAIRS OF THE USSR AND THE CHAIRMAN OF THE KGB AT THE COUNCIL OF MINISTERS OF THE USSR July 16, 1954 No. 127с/0391/078 In pursuance of the instructions of the policymaking bodies, we order: 1. Directive of the USSR MGB and the USSR Prosecutor's Office No. 66/241 ss of October 26, 1948

No. 3 Order of the Revolutionary Military Council of the USSR No. 1962 with the announcement of the resolution of the Council of People's Commissars of the USSR dated August 18, 1923 on the composition of the Revolutionary Military Council of the USSR

No. 3 Order of the Revolutionary Military Council of the USSR No. 1962 with the announcement of the resolution of the Council of People's Commissars of the USSR dated August 18, 1923 on the composition of the Revolutionary Military Council of the USSR No. 196, Moscow September 6, 1923. At the same time, the resolution of the Council of People's Commissars of the USSR dated August 28, 1923 "on the composition of the Revolutionary Military Council of the USSR."Deputy

THE USSR. Healthcare

THE USSR. Healthcare Healthcare The development of the economy and culture, the constant concern of the Soviet state for the welfare and health of the population contribute to the favorable course of demographic processes in the USSR, whose population grew by 1976 compared to

No. 7 FROM THE REPORT OF THE NKGB of the USSR to the Central Committee of the All-Union Communist Party of Bolsheviks, the Council of People's Commissars of the USSR, the NKO of the USSR and the NKVD of the USSR dated March 6, 1941.

No. 7 FROM THE MESSAGE OF THE NKGB OF THE USSR TO THE Central Committee of the All-Union Communist Party of Bolsheviks, the Council of People's Commissars of the USSR, the NGOs of the USSR and the NKVD of the USSR dated March 6, 1941. Message from BerlinAccording to information received from an official of the Committee on the Four-Year Plan, several committee workers received an urgent task to make calculations of raw material reserves And

No. 9 NOTE OF THE USSR People's Commissar of State Security V.N. MERKULOV TO THE Central Committee of the All-Union Communist Party of Bolsheviks, the Council of People's Commissars and the NKVD of the USSR WITH THE TELEGRAM OF THE ENGLISH FOREIGN MINISTER A. EDEN TO THE AMBASSADOR OF ENGLAND TO THE USSR S. CRIPPS ABOUT GERMANY'S INTENTIONS TO ATTACK THE USSR

No. 9 NOTE OF THE USSR People's Commissar of State Security V.N. MERKULOV TO THE Central Committee of the All-Union Communist Party of Bolsheviks, the Council of People's Commissars and the NKVD of the USSR WITH THE TELEGRAM OF THE ENGLISH MINISTER OF FOREIGN AFFAIRS A. EDEN TO THE AMBASSADOR OF ENGLAND TO THE USSR S. CRIPPS ABOUT GERMANY'S INTENTIONS TO ATTACK THE USSR No. 1312/M April 26, 1941 Top Secret Directed

15 RGANI. F. 17. Op. 88. D. 73. L. 49.

16 GARF. F. 327, Op. 1. D 47. L. 59.

17 Ibid. L. 55.

18 Russian State Archive of Socio-Political History (hereinafter referred to as RGASPI). F. 327. Op. 1. D. 4. L. 23.

19 See: GARF. F. 327. Op. 1 D. 32. L. 266, 267, 268.

20 RGANI. F. 17. Op. 88. D. 732. L. 51.

21 See: Russian State Archive of Economics (hereinafter referred to as RGAE). F. 5675. Op. 1. D. 636. L. 48.

22 Ibid. L. 75.

23 Ibid. L. 25.

24 Ibid. D. 546. L. 41.

25 Ibid. D. 595. L. 8.

26 Ibid. L. 12.

27 Ibid. D. 636. L. 100.

28 Ibid. D. 595. L. 13.

29 Ibid. D. 634. L. 3.

30 Ibid. D. 636. L. 99.

31 http://www.gazetaingush.ru/index.php?option=com_ content&view=article&id=6241:2012-02-23-06-33-49&catid=3:2009-05-05-20-23-47&Itemid= 1 (date of access: 03/21/2014)

32 RGAE. F. 5675. Op. 1. D. 543. L. 71.

33 Ibid. D. 595. L. 12.

34 Ibid. D. 632. L. 39.

35 GARF. F. 259. Op. 6. D. 2603. L. 15.

36 Ibid. L. 16.

37 RGANI. F. 17. Op. 88. D. 732. L. 23.

38 Ibid. L. 38.

39 See: RGAE. F. 5675. Op. 1. D. 636. L. 49, 50.

40 Ibid. L. 51.

41 http://www.gazetaingush.ru/index.php?option=com_ content&view=article&id=6241:2012-02-23-06-33-49&catid=3:2009-05-05-20-23-47&Itemid= 1 (date of access: 03/21/2014).

42 GARF. F. 7523. Op. 75. D. 365. L. 8.

43 Ibid. L. 8.

44 Ibid. L. 12, 14.

45 Ibid. D. 364. L. 9, 10.

UDC 614(470.44/.47)(09)|19|

A. A. Gumenyuk

Saratovsky State University Email: [email protected]

The article analyzes the process of transforming specialized medical care into an integral part of Everyday life population of the Lower Volga region during the Khrushchev period

46 See: Myakshey A.P. Decree. op. P. 78.

47 http://www.memorial.krsk.ru/Exile/064.htm (access date: 12/07/2014).

48 RGAE. F. 5675. Op. 1. D. 636. L. 2.

49 For more details, see: Kostyrchenko G.V. Stalin’s secret policy. Power and anti-Semitism. M., 2003. P. 431.

50 http://kirimtatar.com/index.php?option=com_content &task=view&id=278&Itemid=47 (date of access: 03/26/2014).

51 GARF. F. 327. Op. 1. D. 47. L. 61.

52 Bugai N. F. Deportation of the peoples of Crimea. P. 117.

53 in the areas of the evacuated were distributed as follows: Azovsky - 162 people, Alushta - 2447, Belogorsky - 1614, Bakhchisarai - 2364, Balaklava - 2076, Dzhankoysky - 158, Zuisky - 213, Kirovsky - 428, Krasnogvardeisky - 104, Kuibyshevsky - 2312, Kuibaevsky, Kuybyshevsky. Nizhnegorsky - 320, Novoselovsky - 32, Oktyabrsky - 103, Primorsky - 204, Sovetsky -216, Sudak - 2553, Staro-Krymsky - 1374, Simferopol - 214, Yalta - 1119. (Bugai N.F. Deportation of the peoples of Crimea. S. 136).

54 Ibid. P. 136.

55 GARF. F. 327, Op. 1. D. 19. L. 62.

57 RGAE. F. 5675. Op. 1. D. 636. L. 20.

58 GARF. F. 327. Op. 1 D. 47. L. 38.

59 RGAE. F. 5675. Op. 1. D. 636. L. 18.

60 httpVZru.wikipedia.org/wiki/ (date of access: 03/21/2014).

61 RGAE. F. 5675. Op. 1. D. 636. L. 15.

62 GARF. F. 259. Op. 6. D. 577. L. 7.

63 RGAE. F. 5675. Op. 1. D. 740. L. 2, 3.

64 Ibid. D. 546. L. 72.

65 Ibid. D. 740. L. 4.

66 See: GARF. F. 327. Op. 1 D. 186. L. 6, 7.

67 Ibid. L. 63.

68 Ibid. L. 71.

69 See: Myakshev A.P. Decree. op. P. 75.

70 https://m.wikipedia.org/wiki/%CD%E0%F1% (access date: 03/01/2014).

ski and Brezhnev reforms. The article is based on rich factual material extracted from archives, published sources, and periodicals. Key words: healthcare, clinic, hospital, pharmacy, medicines, medical personnel, medical equipment, bed capacity, clinical examination, infectious morbidity.

development of healthcare in the USSR

IN THE SECOND HALF of the 1950s - THE FIRST HALF of the 1980s (based on materials from the Lower Volga region)

Public Health service Development in the USSR in the Second Half of the 1950s - the First Half of the 1960s (Based on the Data of the Lower Volga Region)

The paper is devoted to the analysis of special medical care becoming

an indispensible part of daily life of the Lower Volga region during

Khrushchev's and Brezhnev's Soviet reforms.

This article is based on the vast set of factual materials from the

archives, published sources and periodical press.

Key words: public health service, polyclinic, hospital, drug store,

medicine, medical staff, medical equipment, hospital stock, health

survey, infectious morbidity.

DOI: 10.18500/1819-4907-2015-15-4-108-116

Health is a fundamental, basic condition for the existence of any person. Its condition determines both the degree of vital activity of an individual and society as a whole. Therefore, health protection is the most important area of ​​social policy of any state. In the Soviet Union, the state health care system finally took shape in the late 1930s and early 1940s; it was based on the availability of medical services for all categories of the population. However, the scarcity of funding did not allow this principle to be fully implemented. Therefore, as in the first decade of Soviet power, the production principle of medical care predominantly developed. Because of this, by the beginning of the Great Patriotic War, the USSR, in terms of life expectancy, infant mortality and other demographic indicators, actually remained at the level of the late 1920s. The hard times of war and what followed recovery period acted as indisputable evidence of the need to strengthen state care for the health of the population. The validity of this statement is confirmed by materials characterizing the state of health authorities in the Lower Volga region in the first post-war decade. Thus, in the Astrakhan region in 1944 there were 75 hospitals, 11 maternity hospitals, two dispensaries, with a total of 3,140 beds, which was clearly not enough for the half-million population of the region1. The lack of laboratories, X-ray diagnostic and electrocardiographic rooms in most medical institutions interfered with the timeliness of examination of patients. There was a shortage of medicines and pharmacies, which were often used for living quarters. The construction of new hospitals and clinics was carried out slowly and with poor quality, as, for example, in the Travinsky district of this region2. The situation was no better in the Saratov region, in 30 districts of which there were no X-ray machines, in 82 state farms with a population

from one thousand to two thousand people, medical care was provided by one paramedic, and in 22 MTS and 12 state farms there were no medical institutions at all. Therefore, in the Ivanteevsky, Krasnopartizansky and St. Petersburg districts, cases of mortality among patients were observed. The increase in bed capacity in the regional center (by 40% compared to 1940) was not due to new construction, but due to the use of corridors, staircases, and lobbies in medical institutions as wards. However, the shortage of hospital beds in Saratov remained, especially for surgical, therapeutic, maternity, and tuberculosis beds. In 1954, there were a shortage of 1,500 such places3. Almost the same picture was observed in Stalingrad, in two districts of which (Stalinsky and Dzerzhinsky) there were no medical institutions. The work of infectious diseases hospitals and stations did not satisfy the needs of the city's workers. Ambulance", the construction of a tuberculosis clinic and a number of other medical institutions was carried out at a slow pace. IN district hospitals Power outages were a common occurrence, especially during operations, and there were difficulties in purchasing medications4. Many medical institutions in the region under consideration were located in dilapidated, unsuitable premises, especially in rural areas. A very indicative episode in this regard is an episode from the film “The Chairman” directed by A. Saltykov (1964), when a surgeon played by the young V. Solomin compares a rural hospital with a “smelly chicken hut”, which did not even have the necessary medicines.

Such a deplorable situation with medical care began to change for the better only after the September 1953 plenum of the CPSU Central Committee, from which the report on the reform activities of N. S. Khrushchev was conducted5. In the materials of this and subsequent plenums and congresses of the CPSU Central Committee, the need to bring specialized medical care closer to the rural population, including in areas of virgin lands development, was repeatedly emphasized. Legislative initiatives focused on the need to raise medical care for rural residents to the level that existed in cities. To achieve this, legislation aimed at expanding the construction of rural hospital complexes, both through government funding, and at the expense of the collective farms’ own funds, and exclusively according to standard projects. This rule applied to cities and workers' settlements. The use of private apartments and other unsuitable premises to house medical stations was prohibited6. The Decree of the Council of Ministers of the USSR of January 14, 1960 “On measures to further improve medical care and health protection of the population of the USSR” determined the optimal

the size of the bed capacity of urban and rural hospitals necessary to provide comprehensive qualified medical care to the population. In cities it ranged from 300-400 beds to 600 or more, depending on the population. In rural settlements, it was prescribed to create enlarged district hospitals, which would be comprehensive centers of the district health care level with a number of beds of 100-120 or more. The construction of new rural district hospitals with fewer than 35 beds was allowed only in exceptional cases and with the permission of the Ministry of Health of the Union Republic7. At the same time, a number of party decisions prescribed the creation of comfortable living conditions for health workers, especially in villages8.

The modernization of the material and technical base of healthcare also included measures to eliminate the shortage in providing the population and medical institutions with medicines, as well as improving their quality9. The Ministry of Health of the RSFSR, by its order of January 9, 1957, ordered that dental and denture care be made more accessible to the population through the expansion of the network of self-supporting clinics10. By the end of this decade, a whole package of orders of the Union Ministry of Health was adopted, designed to improve overall outpatient and polyclinic services for the urban population, the work of the ambulance service, as well as to eliminate diphtheria, measles, scarlet fever, whooping cough, typhoid fever, brucellosis, malaria, tularemia , polio, anthrax and tuberculosis11. The government’s increased attention to the healthcare sector is also evidenced by the adoption of new regulations on the Ministry of Health of the USSR (1959, 1964 and 1968) and the RSFSR (1960 and 1969)12.

Residents of the Lower Volga region gradually began to feel the first results from the implementation of the legislative initiatives adopted by the new collective leadership of the USSR in the field of medicine by the mid-1950s, including due to the growth of state allocations for healthcare. So, in the Saratov region for 1951-1955. they doubled and amounted to 215 thousand rubles, in the Stalingrad region - 197 thousand rubles. or 26 thousand more than in 1953.13 Nevertheless, the increase in hospital beds in this region was higher than in Saratov: 44 and 22%, respectively. The same picture was observed in relation to medical personnel14. The hospital network in the Astrakhan region grew much more slowly. In terms of the annual increase in hospital beds, this region, neither in 1958 (4%) nor in 1963 (6%)15, was able to “catch up” with the Stalingrad region, where in 1950-1955. it averaged 7.3%. This is precisely what explains the allocation of an additional 1.5 million rubles from Astrakhan in 1961 by the Council of Ministers of the RSFSR from its reserve funds.

financial resources, of which 0.4 million were intended for the construction of healthcare facilities16. However, much more attention of the republican and union leadership was demanded by the rehabilitated population of the Kalmyk autonomy, recreated by the resolution of the CPSU Central Committee of November 24, 1956, who were returning to their native places17. Only from September 2, 1957 to July 1, 1958, medical equipment and various supplies worth 431.4 thousand rubles were purchased for medical institutions in this region.18 Due to these and other funds19, the number of hospital institutions in this territorial entity increased from 40 units in

1955 to 54 by the beginning of 1960. The number of hospital beds during this period increased from 655 to 1200, and doctors and nursing staff increased from 666 to

1956 to 1339 by the beginning of 1961.20 Medical institutions in the region began to receive new technology, the number of X-ray facilities and clinical laboratories has increased21. But despite the large financial investments in material and personnel support, the health authorities of Kalmykia lagged significantly behind the neighboring regions of the Lower Volga region, among which, according to official statistics, the Saratov region was in the lead. By the beginning of 1961, it had 20,782 doctors and paramedics, 319 hospitals with 19 thousand beds. The second and third places, respectively, were occupied by the Stalingrad and Astrakhan regions22. If we consider only regional centers, then the relationship looks different. Only by such a criterion as the ratio of doctors to population, Stalingrad with 38 doctors per 10 thousand inhabitants was ahead of Saratov with 31 doctors. At the same time, in both cities this figure was higher than the all-Russian level - 19-20 doctors23.

The improvement of the material, technical and personnel base of health care was accompanied by an improvement in medical care for the population. Clinics switched to extended hours of operation on weekdays; in order to reduce queues, pre-registration with specialists was practiced, and patients were received on weekends. Due to the increase in the number of medical stations, medical care became closer and more accessible to patients24. A definite result of all these innovations was the transition from the district to the polyclinic principle of medical care, which occurred in 1962.25 On efficiency measures taken can be judged by the facts mentioned in the sources of a decrease in the number of complaints from the population about the work of health authorities26. The improvement in the functioning of these structures is eloquently evidenced by data on a decrease in infectious and common morbidity in various regions of the Lower Volga region. Thus, in the Saratov region already by the mid-1950s. malaria was eliminated as a mass disease

left, compared to 1946, tuberculosis became 2.3 times less common. In just one year (from 1954 to 1955), the incidence of measles decreased by 21%, scarlet fever by 12%, typhoid fever by 20%, and cheese typhus by 28%. The incidence of brucellosis has decreased, anthrax and tetanus occurred in isolated cases27. From 1958 to 1963 in rural areas of the region, the number of cases of diphtheria decreased by 375, typhoid fever - by 44, dysentery - by 16628. In the region as a whole in 1964, the incidence of diphtheria decreased by 3.5 times, tuberculosis by 18 .5%, polio was practically eradicated, especially among children29.

The decrease in incidence was primarily noticeable in cities. In general, for 1953-1964. In archival documents for the Saratov region, we found 82 references to the growth of various types of infections, of which only 20 documents accounted for urban settlements. In Stalingrad, the incidence of osteoarticular tuberculosis decreased from 2.4% in 1953 to 1.4% in 1955.30 The incidence of temporary disability decreased in the Stalingrad region and subsequently, which can be indirectly judged by reducing the use of funds from the social insurance budget for the payment of temporary disability benefits31. Demographic indicators also indicate an increase in the accessibility of specialized medical care to the population and an increase in its quality. For example, in the Kalmyk Autonomous Soviet Socialist Republic, natural population growth from 1956 to 1958 increased from 20.5% to 26.4%. For 1959-1965 The population of the republic grew by another 38%, the annual increase was approximately 9 thousand people. The average life expectancy of people has increased to 70 years. Infant mortality has decreased, especially in rural areas32. In the Saratov region, the birth rate increased from 18.0% in 1953 to 20.0% in 1961.33 Volgograd in the first half of the 1960s. also had a high natural increase - 14-15 thousand children were born there annually. In the country as a whole, life expectancy has doubled34.

However, the inconsistency and sometimes obvious contradictory nature of many of Khrushchev’s initiatives could not but affect the state of health care. In many settlements of the Lower Volga region, a considerable number of small, low-power hospitals remained. Thus, in the Saratov region in the first half of the 1960s. 11 hospitals serving urban adults had 50 or fewer beds. In Engels, the actual provision of hospital beds per thousand population was 7.3 beds, while the norm was 11,235. The average capacity of central district hospitals was 138, zonal hospitals 70, district hospitals 24.1 instead of the legally required 300-400 beds.

The staff of 76% of rural district hospitals consisted of practically one doctor who provided medical care not much different from paramedic care. 97 hospitals had no X-ray rooms, 75 had no laboratory, and 93 had no physiotherapy equipment. 50% of the rural population received primary medical care at feldsher-midwife stations36. This was often explained not only by economic difficulties, but also by decisions that did not take into account the interests of rural residents. Deprived of any medical care as a result of the closure of unprofitable rural hospitals from the authorities’ point of view, collective farmers were forced to seek “the truth” even from the head of state37. Therefore, it is understandable that the number of references in archival documents to the increase in morbidity among children and adults in rural areas of the region increased from 25 in 1953-1958. to 37 in 1959-1964 However, if we take into account the number of orders expressed by the population to the regional Soviets, the situation in the healthcare sector in the Saratov region was much better than, for example, in the neighboring Volgograd region. Indeed, if in 1961 about 1.7% of orders and wishes were expressed to the deputies of the Saratov Regional Council by voters regarding the construction and expansion of a network of medical institutions, the organization of well-functioning work of communal systems, providing them with transport and medical workers, then in the Volgograd region in 1962, about 23.2% of such orders were received by the regional council, and in 1965 - 19.6%38. There were problems in other regions of the Lower Volga. Thus, in Kalmykia in 1962, only 42.2% of capital investments were spent on the construction of hospital beds, and in 10 months of 1963 - 69%. Due to unsatisfactory working and living conditions, out of 70 doctors sent to the republic in 1963, 5,439 left. For the same reason, in the Astrakhan region, the number of doctors in rural areas practically did not grow. A quarter of all the doctors available in the region worked in Astrakhan villages40. Thus, the data presented allow us to assert that by the end of the Khrushchev decade, highly qualified specialized medical care did not “reach” the majority of the rural population of the region. In villages and villages it never became a mass phenomenon, as evidenced by the speech of the Chairman of the All-Union Central Council of Trade Unions V.V. Grishin at the March 1965 Plenum of the CPSU Central Committee41.

The new leadership of the country, which came to power in mid-October 1964, began to take more decisive measures to improve medical care for the population, while maintaining the continuity of the social course of N. S. Khrushchev. Analysis of materials from party congresses, plenums of the pre-perestroika twentieth anniversary and legislative acts that appeared

in development of the resolutions adopted at these forums, shows that those in power sought to ensure that highly qualified medical care became an integral part of the daily life of not so much the urban as the rural population42. In this regard, the resolution of the Central Committee of the CPSU and the Council of Ministers of the USSR dated July 5, 1968 “On measures to further improve healthcare and develop medical science in the country". A comparison of its contents with a similar resolution of January 14, 1960 convinces of the real desire of the party and government to provide the population with highly qualified medical and preventive care. Thus, in cities, the maximum hospital bed capacity was now supposed to be not 600, but 1000 or more beds, and in rural areas it increased from 120 to 400 beds. The capacity of rural district hospitals was increased to 150 beds. In addition, the document prescribed the organization of inter-republican, republican, interregional, regional and regional departments (centers) for the most important types of specialized medical care (cardiac surgery, burns, neurosurgical, neurological and others)43. These same guidelines were reproduced in similar resolutions of September 22, 1977 and August 19, 1982. At the same time, these documents contained more extensive propaganda of elements than before healthy image life (preventive examinations, clinical examination, sanitary and hygienic education of the population), it was prescribed to pay increased attention to protecting the health of women and children44. The need for a speedy solution to these most important problems was recognized by the delegates of the June 1983 and April 1984 plenums of the CPSU Central Committee45. Thus, the measures developed were aimed at building a welfare state in the USSR.

Implementation of a deliberate program to bring high-quality medical care closer to to a specific person demanded a significant increase in health care funding. Among the regions and republics of the Lower Volga region, it was most large-scale in the Volgograd region: in 1967, almost 64 million rubles were spent on medical services for the population of the region, and in 1975 - already about 96 million rubles.46 If in 1966 medical institutions of the Kalmyk Autonomous Soviet Socialist Republic received the latest equipment worth 176.8 thousand rubles, then in the first half of the 1970s. an average of 400 thousand rubles were spent annually on these purposes.47 The health care budget in the Saratov region was much smaller: 1965 - 52,828 rubles, and 10 years later - 90,586 thousand rubles.48 As a result, the hospital network in the region expanded significantly . During 1966-1985 This process took place most intensively in the Volgograd region, where, as indicated,

Over the past 20 years, the number of beds in hospital institutions has increased by 11,503; in the Saratov region this increase amounted to 8,609 beds, in the Astrakhan region - 6,300, and in the Kalmyk Autonomous Soviet Socialist Republic - only 2,730 units49. However, in terms of provision of population with hospital beds, the leadership was in the Astrakhan region, where by the end of 1985 there were 156.6 thousand beds per 10 thousand people, the second place was occupied by the Kalmyk Autonomous Soviet Socialist Republic with 149 beds, the third place was taken by the Volgograd region (138 beds per 10 thousand .). In the Saratov region, there were only 130 beds per 10 thousand population on January 1, 1986, which was lower than the republican average - 135 beds per 10 thousand population50. Only in some districts of the region did the provision of beds exceed this figure, in particular in Arkadaksky, Ivanteevsky and Rivne51.

The region's treatment and preventive network has changed not only quantitatively, but also qualitatively, becoming more accessible, especially to the rural population. In the Astrakhan region by the mid-1970s. In almost all districts, modern district hospital buildings in combination with clinics were renovated or erected. By this time, 29 interdistrict specialized centers for basic types of medical care had been created in the Saratov region. If in 1975 in the Volgograd region such centers existed only at eight district hospitals, then in 1979 they appeared in 14 districts. In the Kalmyk Autonomous Soviet Socialist Republic in the early 1980s. Medical care in rural areas was provided in 10-12 specialties; the central district hospitals had clinical diagnostic laboratories and physiotherapy rooms52. Successes in the field of healthcare began to be felt by ordinary people53, which was manifested in a reduction in the orders they expressed to local authorities. For example, in the Saratov region from 1969 to 1975, the number of orders decreased by 2.4 times54.

The clearest idea of ​​the degree of access to medical care for the rural population is provided by the ratio of hospital beds to population. Particularly significant in this regard is the period from 1965 to 1975. In the Lower Volga, the population of the Astrakhan region was most fully provided with specialized medical care, where by the end of the IX Five-Year Plan there were 66.3 beds per 10 thousand rural population, which was higher than the republican average level (62.9 per 10 thousand people). In the Volgograd region this figure was not achieved. In this area in the mid-1970s. There were 58.1 beds per 10 thousand residents of villages and hamlets. The worst situation by this time was in the Saratov region, the provision of hospital beds for the rural population of which decreased from 50.9 in 1965 to 49.0 in 1975. The 1965 level in the region was surpassed only in the fall of 1985, but not on the-

a lot: there were 51 hospital beds per 10 thousand rural residents55. Such a meager advantage was partly explained by the implementation of the program for the reconstruction of the settlement structure, which was actively carried out by the state everywhere. Therefore, a reduction in the number of medical institutions was also observed in other regions of the Lower Volga region, in particular in the Astrakhan region56.

The main achievements of the health care system of the country and the region under consideration concerned mainly regional and district centers. This is confirmed by an analysis of the ratio of the number of references in sources to morbidity in rural and urban populations. Thus, in archival documents for the Saratov region from the end of 1964 to the end of 1985, we found 36 references to the growth of various types of diseases, of which only 16 documents accounted for urban settlements. The reduction of such dangerous infections as diphtheria, tularemia, polio, rabies, brucellosis, whooping cough and others in the region was also the result of an increase in the number of medical personnel, improvement of their qualifications, and the organization of dispensary observation of the population. The first successes of this process in the Kalmyk Autonomous Soviet Socialist Republic are evidenced by the fact of an increase in 1965-1966. coverage dispensary observation rural population from 77% to 85%57. Medical care for rural workers of the republic improved in the future, especially during health months. In 1976, the level of medical examination of the entire population of Kalmykia increased to 97.9 per thousand population58. In the Saratov region in 1984, 241 people per thousand people were registered at the dispensary, which was higher than the republican average - 232 people per thousand. By the beginning of 1986, 11.6 thousand doctors of all specialties were guarding the health of the population in this area59. In the Volgograd region, by this time, the health of workers was protected by 10.6 thousand doctors and 30.9 thousand paramedical personnel; in the Astrakhan region, 5.8 thousand and 13 thousand, respectively. By the end of the period under review, much fewer medical workers were listed in the Kalmyk Autonomous Soviet Socialist Republic - only 1.2 thousand doctors60.

The increase in the number of medical personnel has contributed to bringing specialized, highly qualified medical care closer to those in need. This assistance became more accessible to working categories of the population thanks to the assistance that continued since the early 1960s. practices of organizing the reception of patients on weekends, transferring medical institutions to extended operating hours, as well as in the evening. In order to reduce queues in clinics, a coupon system with a preliminary appointment with a doctor was introduced61. All these steps have contributed to reducing the number of workers' complaints about health care. So, in

In the Saratov region, from January to September 1983 alone, the number of such complaints received by the regional committee of the CPSU decreased from 115 to 9962. At the same time, the number of orders on health issues given by voters to deputies of the Supreme Council of the RSFSR and the USSR increased. Thus, in the Saratov region in 1979, about 7.5% of such orders were expressed, and in 1985, about 14%. People were forced to petition the deputies of the Supreme Council by the inaction of local authorities. If in 1975 about 5% of orders were addressed to deputies of the Saratov Regional Council, then in 1979 it was already about 8%63.

It was mainly the population of remote settlements, in which the state’s concern for the health of the population was still weakly felt, that turned to power64. This was a consequence of the entry of the USSR in the late 1970s. into a more severe phase cold war and a significant reduction in the influx of petrodollars into the economy. The weaknesses of social policy gradually manifested themselves with great force. The health care budget began to decline rapidly. If in the first half of the 1970s. in the Kalmyk Autonomous Soviet Socialist Republic, an average of 20% of funds were spent annually on the purchase of the latest medical equipment, then in the early 1980s. - only 9%65. And in certain areas of Saratov and the region in the early 1980s. healthcare financing ranged from 2% to 4%66. These very few funds were directed mainly to regional, district centers and rural areas that were promising from the point of view of the authorities. settlements. All other settlements were deprived of the necessary material support. As a result, the material, technical and personnel base of health care in them gradually approached the level of the early 1950s. The shortage of specialized specialists was felt in the “unpromising” villages of Olkhovsky, Bykovsky, Oktyabrsky, Nekhaevsky districts of the Volgograd region67. The population of the Arkadaksky, Ivanteevsky, Engelssky, Novoburassky, Balashovsky districts of the Saratov region complained of crowded conditions in medical institutions, where two specialists treated patients in one room68. District hospitals worked in cramped conditions in Priyutny, Sovetsky, Yashalta, Komsomolsky, Troitsky, and it was crowded in the Central District Hospital of Priozerny and Chernozemelny districts of the Kalmyk Autonomous Soviet Socialist Republic69.

The anthropogenic factor also influenced the decline in the quality of medical care throughout the period under review. The harmony between the external and internal decoration of medical institutions erected in large numbers using the latest science and technology was quickly disrupted. The image of a hospital or clinic began to be destroyed in the process of equipping them with medical equipment, which was often accompanied by damage to the covering of walls, floors and ceilings. Those who moved into

In medical institutions, medical workers, settling into their workplaces, thought, first of all, about their own coziness and comfort and, last of all, about how the patients who came to the appointment would feel this way. This was manifested, firstly, in the irrational arrangement of furniture, creating inconvenience for patients. Secondly, the interests of visitors to medical institutions were sacrificed to the desire of the head doctors to save on water and electricity: caretakers unscrewed light bulbs in common areas and closed the doors to toilet rooms, considering them superfluous70. Faced with such everyday troubles, workers tried to avoid going to the doctor, especially if there was no serious need for this. As a result, such important events as medical examinations or medical examinations turned into a formality, and this, in turn, led to a decrease in people’s quality of life. However, compared to the period of the “Khrushchev Thaw” in 1965-1985. highly qualified specialized medical care has nevertheless become more accessible to the population, especially rural ones. So, in the Saratov region for 1953-1964. We found 62 references in archival documents to the increase in morbidity among rural residents, and over the next 20 years - only twenty such references, and the vast majority of these concerned the adult population. Information about morbidity among children was extremely rare, which once again proves the effectiveness of the “Physical Education and Sports” project, the implementation of which began in 1966.71 The population of the Astrakhan, Volgograd regions and Kalmyk Autonomous Soviet Socialist Republic by the mid-1980s. highly qualified specialized medical care also became more accessible, since, as is clear from the above, the provision of hospital beds for the population was higher than the national average.

The existing differences in the degree of access to medical care for workers in each of the regions of the Lower Volga are explained by the status of a particular subject of the region and the resulting amount of funding, as well as the ability of local leadership to defend the interests of the population of a given region or republic before the union or republican government. Residents of the hero city of Volgograd and Saratov, which is closed to foreigners, were in a relatively privileged position in this regard. The population of Astrakhan and Elista, with the exception of the party nomenklatura, was deprived of any advantages. Nevertheless, during the pre-perestroika thirty years, specialized medical care became an integral part of the daily life of the ordinary Soviet person, which contributed to a significant improvement in the quality of his life.

Notes

1 History of the Astrakhan region. Astrakhan, 2000. P. 800.

2 See: GARF. F. A-482. Op. 50. D. 214. L. 54; Volga. 1953. 14. 02. L. 3; 21.10. L. 3; 25.11. L. 3.

3 See: GANISO. F. 594. Op. 2. D. 2888. L. 12-13; D. 3052. L. 119-120.

4 See: GAVO. F. R-523. Op. 1. D. 124. L. 142-143; D. 336. L. 24, 45-46; F. R-2115. Op. 6. D. 301. L. 204; Stalingrad truth. 1953. 10. 01. L. 3; 17. 03. L. 3; 1955. 3. 09. L. 3. 16. 09. L. 3.

5 CPSU in resolutions and decisions of congresses, conferences and plenums of the Central Committee. T. 8. 1946-1955. M., 1985. P. 344.

6 See: GANISO. F. 594. Op. 2. D. 2728. L. 275; D. 4522, L. 5a; F. 129. Op. 31. D. 29. L. 4; RGANI. F. 3. Op. 3. D. 18. L. 12; CPSU in resolutions... T. 8. P. 368, 528; T. 9. 1956-1960. M., 1986. S. 48-487; Resolutions of the 20th Congress of the Communist Party of the Soviet Union. February 14-25, 1956 M., 1956. P. 85-85; SP USSR 1957. No. 16. Art. 162; SP RSFSR 1960. No. 4. Art. 9 ; Materials of the Extraordinary XXI Congress of the CPSU. M., 1959. P. 239; Materials of the XXII Congress of the CPSU. M., 1962. S. 76, 392.

7 See: SP USSR. 1960. No. 3. Art. 14 ; GANISO. F. 594. Op. 2. D. 3854. L. 14-15 vol.

8 See: RGANI. F. 3. Op. 31. D. 21. L. 23; Plenum of the CPSU Central Committee March 5-9, 1962. Verbatim report. M., 1962. P. 394.

9 See: SP USSR. 1957. No. 5. Art. 54; 1962. No. 7. Art. 58; Health care legislation. T.VI. M., 1963. S. 647-649.

10 See: GANISO. F. 594. Op. 2. D. 3854. L. 6, 57-58 a vol.

11 See: Health care legislation. T. IV. M., 1960. S. 196-200, 227-233, 238-241, 251-255; T.VI. pp. 201-202, 234-235, 299-301; RGANI. F. 3. Op. 31. D. 21. L. 109.

12 See: SP USSR 1959. No. 19. Art. 158; 1964. No. 24. Art. 142; 1968. No. 14. Art. 91; SP RSFSR. 1960. No. 11. Art. 46; 1969. No. 9. Art. 45.

13 See: GANISO. F. 594. Op. 2. D. 3439. L. 71; TsDNIVO. F. 113. Op. 52. D. 1. L. 67.

14 In the Stalingrad region in 1955 there were 2,459 doctors, and in the Saratov region there were only 1,301 doctors. (See: GAVO. F. R-523. Op. 1. D. 453. L. 25; GANISO. F. 594. Op. 2. D. 3334. L. 233, 239.)

15 See: Volga. 1959. 10.02. L. 3; 1964. 25.01. L. 3.

16 GARF. F. A-259. Op. 42. D. 6028. L. 1 vol.

17 See: RGANI. F. 89. Op. 61. D. 13. L. 1-7.

18 Calculated according to: GARF. F. A-259. Op. 42. D. 1959. L. 29.

19 During the period from 1960 to June 1964, 147 thousand rubles were spent on the purchase of medical equipment. (See: Doynikova E. A., Sysoev P. N. On the length of health // 50 years under the banner of October. Elista, 1967. P. 180.)

20 See: Essays on the history of the Kalmyk ASSR. The era of socialism. M., 1970. P. 358; National economy of the RSFSR in 1960. Statistical yearbook. M., 1961. S. 521, 532, 536.

21 See, for example: GAVO. F. R-523. Op. 1. D. 336. L. 45; Volga. 1956. 26.01. L. 1; 30.11. L. 1; Komsomol member of the Caspian Sea. 1960. 16.12. L. 3.

22 See: National Economy of the RSFSR in 1960, pp. 521, 532, 536.

23 See: Vodolagin M.A. Essays on the history of Volgograd. M., 1969. P. 418; GANISO. F. 136. Op. 19. D. 88, L. 129.

24 See: GARF. F. A-482. Op. 50. D. 1229. L. 35; GANISO. F. 74. Op. 34. D. 43. L. 26; F. 2329. Op. 35. D. 57. L. 64; D. 78. L. 103; GASO. F. R-1738. Op. 3. D. 932. L. 4.

25 See: GANISO. F. 594. Op. 2. D. 4914. L. 54-55; Communist. 1962. 30.10. L. 3.

26 See: GANISO. F. 2485. Op. 26. D. 1. L. 77; F. 136. Op. 14. D. 1. L. 176; Op. 19. D. 18. L. 169-169 vol. ; GASO. F. R-1738. Op. 3. D. 1294. L. 2; D. 1239. L. 2; Soviet Kalmykia. 1961. 12.12. L. 4.

27 See: GANISO. F. 594. Op. 2. D. 3334. L. 266, 274, 301-302.

28 Calculated by: GANISO. F. 1012. Op. 1. D. 268. L. 215.

29 See: GASO. F. R-1738. Op. 4. D. 199. L. 3, 10-11; Op. 7. D. 613. L. 23.

30 Komochkov A.V. Analysis of the incidence of osteoarticular tuberculosis in Volgograd // Health care in the Volgograd region. Volgograd, 1963. P. 4.

31 See: GAVO. F. R-523. Op. 1. D. 453. L. 24. D. 858. L. 23.

32 See: Essays on the history of the Kalmyk ASSR. pp. 353, 373; Soviet Kalmykia. 1957. 22.09. L. 3

33 See: GANISO. F. 594. Op. 2. D. 3052. L. 86; D. 4864. L. 59.

34 See: VodolaginM. A. Decree. op. P. 418; CPSU in resolutions... T. 11. 1966-1970. M., 1986. P. 318.

35 See: GASO. F. R-1738. Op. 4. D. 199. L. 4 vol., 24; Op. 7. D. 613. L. 6.

36 See: GANISO. F. 1012. Op. 1. D. 268. L. 210-211.

37 Ibid. F. 5411. Op. 1. D. 1. L. 35; F. 1012. Op. 1. D. 136. L. 10, 12, 19 rev., 20 rev. - 21 rev., 23 rev. - 24 rev., 41.

38 Calculated according to: GASO. F. R-1738. Op. 1. D. 1068; GAVO. F. R-2115. Op. 6. D. 1877, 2026.

39 Soviet Kalmykia. 1963. 26.11. L. 3.

40 See: History of the Astrakhan region. P. 834; Volga. 1959. 20.01. L. 3; 21.01. L. 3; 1962. 10.01. L. 3.

42 See: Materials of the XXIII Congress of the CPSU. M., 1966. S. 162, 262-263; Materials of the XXIV Congress of the CPSU. M., 1972. P. 181; Materials of the XXV Congress of the CPSU. M., 1976. S. 123, 220; Materials of the XXVI Congress of the CPSU. M., 1981. S. 106, 182, 183; SP USSR 1966. No. 9. Art. 93; 1973. No. 25. Art. 144; SP RSFSR 1968. No. 15. Art. 76; Food program of the USSR for the period until 1990 and measures for its implementation: materials of the May Plenum of the CPSU Central Committee in 1982. M., 1984. P. 58, 103.

43 SP USSR. 1968. No. 13. Art. 82.

44 See: CPSU in resolutions... T. 13. 1976-1980. M., 1987. S. 206-211, 215-216; T. 14. 1981-1984. M., 1987. pp. 366-368.

45 See: Andropov Yu. V. Leninism is an inexhaustible source of revolutionary energy and creativity of the masses.

Selected speeches and articles. M., 1984. S. 478, 480; CPSU in resolutions... T. 14. P. 523-524.

46 See: Volgogradskaya Pravda. 1968. 14.02. L. 3; 1976. 17.02. L. 3.

47 See: Essays on the history of the Kalmyk ASSR. P. 391; Su-seev P. Ya. Achievements of healthcare in Kalmykia during the years of Soviet power // Healthcare of the Russian Federation. 1978. No. 11. P. 9.

48 See: Communist. 1965. 11. 07. L. 3; GASO. F. R-1738, Op. 8. D. 1304. L. 33.

49 Calculated from: Volga. 1971. 21.01. L. 2; 1976. 1.01. L. 3; Volgograd truth. 1971. 23.01. L. 2; TsDNIVO. F. 113, Op. 98. D. 1. L. 30; Op. 110. D. 3. L. 13; GANISO. F. 594. Op. 14. D. 99. L. 128; GASO. F. R-1738. Op. 8. D. 1189. L. 4; Op. 8-ave. D. 1774. L. 15; Soviet Kalmykia. 1971. 20.01. L. 2; 1981. 23.02. L. 3; 1986. 21.01. L. 2; National economy of the RSFSR in 1975. Statistical yearbook. M., 1976. P. 416; National economy of the RSFSR in 1980. Statistical yearbook. M., 1981. P. 305; National economy of the RSFSR in 1984. Statistical yearbook. M., 1985. S. 364, 365; National economy of the RSFSR in 1985. Statistical yearbook. M., 1986. S. 360, 361.

50 See: Volga. 1986. 7.02. L. 3; Soviet Kalmykia. 1981. 5.11. L. 2; National Economy of the RSFSR in 1985, pp. 362, 363; Communist. 1986. 1.02. L. 2; GANISO. F. 594. Op. 33. D. 1. L. 137.

51 See: GANISO. F. 5. Op. 56. D. 1. L. 60; F. 196. Op. 51. D. 1. L. 74; Op. 65. D. 1. L. 45; F. 4816. Op. 44. D. 1. L. 19.

52 See: Petrova V. Ya. Problems of rural life in the activities of party organizations in the Lower Volga region (1965-1975): dis. ...cand. ist. Sci. Saratov, 1988. S. 132, 134-135; GANISO. F. 594. Op. 18. D. 1. L. 27; GAVO. F. R-523. Op. 1. D. 1600. L. 51; TsDNIVO. F. 113. Op. 110. D. 96. L. 101-102; Soviet Kalmykia. 1983. 29.10. L. 3.

53 See: Communist. 1970. 9.09. L. 4; Volga. 1976. 24.03. L. 2; GAVO. F. R-523. Op. 1. D. 1318. L. 149.

54 Calculated by: GASO. F. R-1738. Op. 8. D. 139, 1108.

55 See: Petrova V. Ya. Decree. op. P. 136; GANISO. F. 138. Op. 44. D. 35. L. 10.

56 See: History of the Astrakhan region. P. 839.

57 Calculated from: Naminov L.V. History of the organization of health care and medical care in the Kalmyk Autonomous Soviet Socialist Republic: abstract. dis. ...Dr. med. Sci. Rostov n/d, 1968. P. 14.

58 See: Soviet Kalmykia. 1973. 16.06. L. 4; Suse-ev P. Ya. Decree. op. P. 9.

59 See: GANISO. F. 138. Op. 44. D. 35. L. 12; Communist. 1986. 1.02. L. 2.

60 See: Volgogradskaya Pravda. 1986. 1.02. L. 2; Volga. 1986. 7.02. L. 3; Soviet Kalmykia. 1986. 25.01. L. 3.

61 See, for example: Reznikov V.D. Stages of development of Soviet healthcare in Saratov // 50 years of Soviet healthcare in Saratov. Saratov, 1969. pp. 11-12; GANISO. F. 594. Op. 32. D. 147. L. 3, 6, 10, 13, 17, 19, 24, 38, 40, 45, 46; F. 77. Op. 41. D. 1. L. 52; F. 3509. Op. 46. ​​D. 1. L. 61; F. 196. Op. 65. D. 24. L. 52.

62 See: GANISO. F. 594. Op. 15. D. 3. L. 4-5; Op. 32.

D. 138. L. 11; F. 4254. Op. 28. D. 12. L. 14; Op. 29. D. 9. L. 19; F. 138. Op. 30. D. 1. L. 81; F. 5. Op. 60. D. 15. L. 6; F. 341. Op. 29. D. 16. L. 14, 17; TsDNIVO. F. 113. Op. 98. D. 1. L. 47.

63 Calculated by: GASO. F. R-1738. Op. 8. D. 1108; Op. 8-ave. D. 1588 a, 1588 b, 2538.

64 See, for example: GAVO. F. R-2115. Op. 11. D. 1207. L. 30; D. 1348. L. 104; TsDNIVO. F. 113. Op. 110. D. 3. L. 53; D. 96. L. 102, 108.

65 See: Suseev P.Ya. Decree. op. P. 9; Soviet Kalmykia. 1981. 5.11. L. 2.

66 See: Pages of Life. History of the Kirov district

in the city of Saratov (1936-2001). Saratov, 2001. P. 93; GANISO. F. 85. Op. 56. D. 1. L. 51.

67 See: GAVO. F. R-523. Op. 1. D. 2050. L. 72;

68 See: GANISO. F. 5. Op. 56. D. 1. L. 35; F. 77. Op. 45. D. 14. L. 18; F. 196. Op. 65. D. 15. L. 30-31; F. 470. Op. 46. ​​D. 1. L. 56; F. 3193. Op. 46. ​​D. 1. L. 78.

69 See: Soviet Kalmykia. 1981. 5.11. L. 2; 1983. 26.10. L. 3; 29.10. L. 3.

70 See: Made in the USSR. M., 2001. S. 194-195.

71 Materials of the XXIII Congress of the CPSU. P. 162; Materials of the XXV Congress of the CPSU. P. 222; Materials of the XXVI Congress of the CPSU. pp. 106, 183.

healthcare in the ussr

Healthcare of the USSR in the post-war period (1952-1991)

During these years, there was a search for new forms and methods of providing medical and preventive care to the population.

A reform of health care management in rural areas was carried out. District health departments were abolished, and all administrative and economic functions in relation to district health care institutions were transferred to the district hospital, chief physician which he became the chief physician of the region. Central district hospitals became organizational and methodological centers of qualified medical care.

In the 1960s, along with the further development of the network of medical institutions, more and more attention was paid to the development of specialized services, providing the population with ambulance and emergency medical care, dental and radiological care. Specific measures were taken to reduce the incidence of tuberculosis, polio, and diphtheria. The construction of large multidisciplinary hospitals and increasing the capacity of existing central district hospitals to 300-400 beds with all types of specialized care was considered by the Minister of Health S.V. Kurashov as the general line of health care development.

More attention began to be paid to organizing medical care for patients with respiratory pathologies, cardiovascular, oncological, and allergic diseases.

However, it was increasingly clear that the results of the activities of health authorities ceased to correspond to the needs of the population and the pressing tasks of the time.

Health care financing continued to be carried out on a residual basis. Compared to other countries in the world, where funding is assessed based on the share of national income spent on healthcare, in the 1970s-1980s the USSR ranked in the 7th ten countries. An assessment of the share of the state budget spent on these purposes showed that this share has been steadily declining: 1960 - 6.6%, 1970 - 6.1%, 1980 - 5.0%, 1985 - 4 .6%, 1993 - 3.5%. The increase in allocations in absolute terms barely covered the costs associated with the growth of the country's population.

Healthcare began to be included in the service sector, and the attention of the administrative and managerial apparatus to protecting people's health decreased.

The preventive direction of medicine in its traditional understanding as the fight against mass, mainly infectious, acute diseases through sanitary and anti-epidemic measures has begun to exhaust itself. One of the reasons for this is the rapid transformation of pathology: the increasing predominance of non-epidemic chronic diseases, which form the basis of the modern structure of mortality and morbidity. New questions have arisen related to the underestimation not only in the 1930s-1940s, but also in the 1950s-1960s of environmental and occupational health problems. Thus, as before, the declared preventive direction was not carried out in practice; the medical section of the work prevailed among doctors, while doctors dealt with prevention formally, often “for the report.”

A special place belongs to the importance of extensive ways of developing healthcare. There is no doubt that at a certain stage of development, when many health problems were associated with a shortage of doctors, hospitals, clinics, and sanitary and epidemiological institutions, these ways played their role. But they could lead to success only to a certain extent, under certain conditions. The moment was missed when it was necessary to make a qualitative leap from quantitative indicators of health care development on the basis of additional funding, a different approach to the use of resources, the search for new forms and methods of work at all levels of health care with the inclusion of material incentives, and new approaches to personnel training. Despite the continued growth of the network and the number of medical personnel, the provision of the population with doctors and beds was far from desired, the availability of highly qualified and specialized care was decreasing and was insufficient even in cities. The shortage of medicines, medical devices and equipment continued. The morbidity and mortality rate of the population decreased at an insufficient pace. Objectives in the field of healthcare were determined by the resolutions of the Central Committee of the CPSU and the Council of Ministers of the USSR “On measures to further improve healthcare” (1960, 1968, 1977, 1982): to develop long-term plans for the development and rational placement of a network of outpatient clinics, taking into account the number and structure of the population served population, meaning full provision of the population with all types of highly qualified and specialized medical care, expansion of the scope of mass preventive examinations and medical examinations; carry out the construction of large, predominantly independent clinics with a capacity of 750 or more visits per shift; when deploying new treatment and diagnostic rooms in clinics, strictly observe sanitary standards; ensure a radical improvement in the organization of the work of registries, taking into account specific conditions, introduce new forms and methods of their work: self-registration of patients, expansion of information about the opening hours of treatment, diagnostic and treatment rooms, pre-registration by telephone and others, make wider use of automated systems for these purposes; expand the introduction into the activities of healthcare institutions of progressive forms and methods of organizing the work of doctors, aimed at maximizing their release from work not directly related to the examination and treatment of patients (dictaphone method of maintaining documentation, the use of cliche stamps, prescription books, etc. ); organize, in agreement with the executive committees of local Councils of People's Deputies, the operating hours of outpatient institutions, ensuring the provision of specialized medical care in the required volume by treatment, diagnostic, X-ray rooms and laboratories outside of working hours on all days of the week, incl. Saturdays, and on Sundays and holidays ensure that general practitioners are on duty to receive patients in the clinic and provide medical care and carry out medical prescriptions for patients at home; carry out in 1978 - 1985 the disaggregation of territorial therapeutic and pediatric areas, increasing the number of adult population served per local general practitioner in 1982 to an average of 2 thousand people and by 1985 to an average of 1.7 thousand people, and the number By 1980 - 1982, the number of children served per local pediatrician averaged up to 800 people. To ensure, starting from 1978, an annual increase in the number of medical positions of local therapists and pediatricians and their full staffing with doctors; establish, starting in 1978, specific annual tasks for regional (territorial) health departments and ministries of health of autonomous republics for the disaggregation of medical districts and an increase in the number of positions of local therapists and pediatricians. Exercise strict control over compliance with planned discipline at the local level; Improve the work of ambulance and emergency medical care institutions, strengthen their material and technical base, and begin the construction of emergency medical care stations and substations according to standard designs; to ensure by 1985 in all regional, regional, republican centers and large industrial cities the organization of emergency hospitals combined with emergency medical stations; ensure the further development of emergency specialized medical care, primarily the organization of cardiology teams, teams intensive care, pediatric, toxicological, traumatological, neurological and psychiatric. Order of the USSR Ministry of Health dated October 31, 1977 N 972 On measures to further improve public health care (from the website http://www.bestpravo.ru)

Much of these resolutions also remained at the level of declarations; instead of cardinal decisions, optional half-measures were provided for.

On the other hand, the forms and methods of treatment and preventive care that have developed over decades have largely justified themselves and received international recognition. WHO positively assessed the principles of Soviet health care. An international meeting in Almaty (1978) under the auspices of WHO recognized the organization of primary health care in the USSR and its principles as one of the best in the world.

During these years, a lot of work has been done to improve the quality of training of doctors. At medical institutes, the curriculum and training programs are being improved, the 6th year is being introduced - subordination and after graduation - internship with an exam in the main specialty. "PUBLIC HEALTH AND HEALTH CARE" Ed. prof. V.A. Minyaeva, prof. N.I. Vishnyakova Sixth edition, 2012./page. 36-37

On December 26, 1991, the USSR collapsed. Political, economic and social changes have led to the need to revise the system of treatment and preventive care for the population.

Thus ends a hugely significant chapter in the history of Russia called “Soviet healthcare.” Over 74 years, the state managed to build a strong health care system (despite all the difficulties that the USSR went through), which evokes admiration and respect from everyone who became familiar with the organization of health care in the USSR.